The early-stage international study, published in the journal Nature Medicine, focused on removing a harmful protein from a mother’s blood.

Preeclampsia is marked by high blood pressure that can quickly become life-threatening. In its most severe early form—before 34 weeks of pregnancy—physicians frequently must deliver babies prematurely to protect the mother, even though early delivery can pose significant risks for the infant. The method tested by investigators was found to safely extend pregnancy, giving babies more time to develop before birth.

“Even a few extra days in the womb can make a meaningful difference in outcomes for premature infants,” said co-corresponding study author Ananth Karumanchi, MD, professor of Medicine, director of the Renovascular Research Center and the Medallion Chair in Vascular Biology at Cedars-Sinai. “We found a way to potentially buy that time safely. Our approach could shift how we manage very early preeclampsia.”

The approach focuses on a protein called sFlt-1, which is produced by the placenta and known to damage blood vessels and drive preeclampsia symptoms. Investigators engineered a specialized immune protein that binds to sFlt-1 and incorporated it into a blood-filtering device. Using a process called extracorporeal apheresis—similar to kidney dialysis—they were able to filter the mother’s blood and remove excess sFlt-1 without affecting other essential blood components.

The treatment was evaluated in 16 women. Their blood pressure improved, their babies continued to grow normally during treatment, and they remained pregnant for an average of 10 additional days—more than double the time seen in untreated patients.

“Right now, the only way to cure preeclampsia and protect the life and health of the mother is to deliver the baby,” said Sarah Kilpatrick, MD, PhD, an expert in maternal-fetal medicine and chair of the Department of Obstetrics and Gynecology at Cedars-Sinai. “That puts very premature infants at high risk. This approach could give clinicians more flexibility in managing these high-risk cases.”

Researchers say the treatment is notable also because it removes a harmful factor rather than introducing new drugs, potentially reducing the risk of side effects. However, they note that despite the small study’s positive results, the treatment is experimental and needs to be tested in larger clinical trials.

“Our goal was to directly target one of the root causes of preeclampsia,” said the study’s co-corresponding author Ravi Thadhani, MD, MPH, executive vice president of Clinical Affairs, chief medical officer for Cedars-Sinai Medical Center and Cedars-Sinai Health System. “By lowering sFLt-1, we were able to stabilize patients and extend pregnancy—a meaningful and exciting step forward.”

Additional Cedars-Sinai authors include Agnes Lo.

Other authors include Thomas F. Hiemstra, Manu Vatish, Holger Stepan, Ana Sofia Cerdeira, Jeremy Brockelsby, Tim James, Massimiliano Lia, Alissa Cornelis, Elena Krause, Martin R. Spath, Berthold Grüttner, Polina Todorova, Henning Hagmann, Kristen R. Yeung, Bei Xu, Scott Heffernan, Suzanne Pears, Richard Waugh, John Thompson, Jim Iliopoulos, Neroli Sunderland, Murray Killingsworth, Angela Makris, Annemarie Hennessy, Adelene Y. Tan, Paul Kussie, Yuchiao Chang, Linda Hanssens, Stefan Miltenyi and Thomas Benzing.

Funding: This work was supported by Miltenyi Biomedicine and Aggamin Pharmaceuticals.

Competing Interests: R.T. and S.A.K. are co-inventors on multiple biomarker patents related to preeclampsia that have been out-licensed to several companies (Thermo Fisher Scientific, Beckman Coulter, Siemens and Roche) and report financial interest in Aggamin Pharmaceuticals and serving as a consultant to Comanche Biopharma. R.T. and S.A.K. are named as co-inventors on a provisional patent held by Cedars-Sinai Medical Center on a novel lateral-flow diagnostic assay for use in preeclampsia and related conditions. A.H. is an advisor to Comanche Biopharma. A.Y.T. and P.K. are employees of Aggamin.

Pharmaceuticals. L.H. is an employee of, and S.M. is the founder of, Miltenyi Biomedicine. All other authors disclose no conflicts. These financial interests have been disclosed in accordance with journal policies.

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Suze Lopez, a nurse from Bakersfield, California, was scheduled to finally have a 22-pound ovarian cyst removed; one that had been growing for years. But the results of a routine pregnancy test that was required before the surgery would give her the shock of a lifetime.

“Because of the large ovarian cyst that had been growing for years, it could have been a false positive, even ovarian cancer,” Lopez said. “And I was used to very irregular periods and some abdominal discomfort. I could not believe that after 17 years of praying, and trying, for a second child, that I was actually pregnant.”

Three days after finding out she was pregnant, the 41-year-old emergency room nurse shared the good news with her husband, Andrew, during a date night at a Dodgers baseball game in Los Angeles. But during the trip Lopez started having pain in her abdomen and they headed to Cedars-Sinai.

When they arrived at the medical center, Lopez had dangerously high blood pressure. John Ozimek, DO, medical director of Labor and Delivery, and his team got to work, stabilizing her blood pressure and ordering an MRI, blood work and an ultrasound.

Ozimek was stunned by what the diagnostic images revealed: a very rare abdominal ectopic pregnancy.

“Suze was pregnant, but her uterus was empty, and a giant benign ovarian cyst weighing over 20 pounds was taking up so much space,” Ozimek said. “We then discovered a nearly full-term baby boy in a small space in the abdomen, near the liver, with his butt resting on the uterus. A pregnancy this far outside the uterus that continues to develop is almost unheard of.”

Ozimek said that as the baby grew inside Lopez’s abdomen, behind the mass, it pushed the very large cyst forward. “It makes sense that she just thought the tumor was getting bigger again, not that she could be pregnant.”

What Is an Abdominal Ectopic Pregnancy?

In an abdominal ectopic pregnancy, the fertilized egg implants outside the uterus, often on vital organs or major blood vessels. The placenta cannot safely grow there, creating an exceptionally high risk of catastrophic maternal bleeding and fetal death. A surviving infant is extraordinarily rare and often faces severe medical complications.

“It was profound to see this full-term baby sitting behind a very large ovarian tumor, not in the uterus. In my entire career, I’ve never even heard of one making it this far into the pregnancy,” said gynecological oncologist Michael Manuel, MD, of Providence Cedars-Sinai Tarzana Medical Center, who was called in to remove the giant cyst.

“We had to figure out how to deliver the baby with a placenta and its blood vessels attached in the abdomen, remove the very large ovarian mass and do everything we could to save mom and this child,” Manuel said.

Delivering a Medical Miracle

It took a team of about 30 experts to pull off a highly coordinated, complex delivery and surgery. Maternal-fetal medicine specialists, gynecological oncologists, nurses, anesthesiologists and a host of specially trained surgical technicians filled the operating room to near capacity. 

Manuel lifted the massive dermoid cyst out of the way so Ozimek and team could quickly deliver the baby and hand him off to the Neonatal Intensive Care Unit (NICU) staff. Then they got back to work.

“As soon as the baby was delivered, Lopez started hemorrhaging badly. We were a specially trained team of obstetric anesthesiologists and well prepared, but it was still intense,” said anesthesiologist Michael Sanchez, MD. “I had already powered up a special machine that delivers blood products fast because every second matters. We used 11 units of blood.”

Cedars-Sinai is the only Level IV Maternal Care hospital in California, a designation earned for its ability to provide comprehensive care for mothers before birth, throughout labor and delivery and after childbirth.

“The ability to provide this level of highly trained, coordinated and multidisciplinary care for extremely high-risk patients can make a critical difference in the health of both mother and baby, as we saw in this extraordinary case of Suze and Ryu Lopez,” said Sarah J. Kilpatrick, MD, PhD, chair of the Department of Obstetrics and Gynecology.

The medical team was elated to see that after such a rare and dangerous pregnancy, the little boy the Lopezes named Ryu came into the world with very few health problems, a full head of hair and weighing 8 pounds.

Sara Dayanim, MD, a neonatologist with Cedars-Sinai Guerin Children’s, said a critical concern was whether his lungs had developed properly and if they would be functioning.

“We were very prepared to handle any lung problems the baby might have. But he came out of anesthesia pretty quickly and he was feisty,” Dayanim said. “The following day we were able to remove the breathing tube, and over the course of his two weeks with us, Ryu quickly reached all of the important benchmarks for surviving well. He defied all the odds.”

The Nurse Angel

Like her newborn, Lopez was feisty and focused on recovering quickly so she could spend time in the NICU with Ryu, her husband and teenage daughter, Kaila. She especially remembers Carmen Chavez, MSN, RN, assistant manager of the Maternal-Fetal Care Unit, for coming alongside her before and after the challenging delivery and surgery. Lopez still refers to as her guardian angel through it all.

“She checked on me so often,” Lopez said. “She sat in on the consults with doctors to make sure we understood everything I was facing at a difficult time. She even helped us tell my daughter about the pregnancy. I’m a nurse myself, but what Carmen did was above and beyond. It meant everything.”

Chavez said she felt Lopez deserved all the support she could get.

“This was an exceptionally high-risk case, and we had to plan every detail,” Chavez said. “It was all hands on deck for our nursing team. Knowing the complexities of Suze’s situation, knowing the challenges she and her baby were about to face, I wanted to stay close.”

Ryu’s parents believe he is the answer to years of praying for a second child. Andrew Lopez said that is why they chose “Jesse” for Ryu’s middle name; it means “gift from God.” 

“He is our gift. And Ryu and Suze are my miracles,” Lopez said. “They let me in the operating room, and it was tough to watch what she was going through, and amazing to see Ryu delivered. So yes, many prayers have been answered.”

“I appreciate every little thing. Everything. Every day is a gift and I’m never going to waste it,” Suze Lopez said. “God gave me this baby so that he could be an example to the world that God exists—that miracles, modern-day miracles, do happen.”

Read more from the Cedars-Sinai Newsroom: Cedars-Sinai Earns Highest Designation for Maternal Care

A Level IV Maternal Care hospital, also known as a Regional Perinatal Health Care Center, provides comprehensive care before birth, throughout labor and delivery and after childbirth. The Joint Commission Maternal Levels of Care (MLC) Verification program operates in collaboration with the American College of Obstetricians and Gynecologists and recognizes the devotion to patient safety and quality of care.

Facilities with this top designation must be staffed with maternal-fetal medicine specialists and critical care physicians to deliver multidisciplinary and integrated treatment for patients with complex obstetric complications such as severe preterm preeclampsia or maternal heart disease.

Level IV medical centers also collaborate with other hospitals by providing medical education and easy access to consultations and transfers to Cedars-Sinai, if needed.  

“Access to this comprehensive level of specialty care can make a crucial difference in the health of both mother and baby and has been proven to reduce maternal morbidity,” said Sarah J. Kilpatrick, MD, PhD, chair of the Department of Obstetrics and Gynecology at Cedars-Sinai and an expert in maternal-fetal medicine.

“This Level IV verification recognizes our ability to provide coordinated, multidisciplinary care involving obstetricians, maternal-fetal medicine specialists, anesthesiologists, cardiologists, neurologists and any other specialty needed to effectively care for these extremely high-risk patients,” Kilpatrick said.

Approximately 3.6 million babies are born each year in the United States, including about 6,000 at Cedars-Sinai, one of the busiest labor and delivery hospitals in California.

The only other hospital in California to be formally verified for any level of maternal care by The Joint Commission is Torrance Memorial Medical Center, an affiliate of Cedars-Sinai. In 2023, Torrance Memorial received verification as a Level III Maternal Care facility.

“The Joint Commission commends Cedars-Sinai for being named a Level IV Maternal Care verified facility and for its efforts to standardize maternal care and reduce maternal morbidity and mortality,” said Ken Grubbs, DNP, MBA, RN, executive vice president of Accreditation and Certification Operations and chief nursing officer at The Joint Commission.

Hospitals receive Level IV designation following an on-site evaluation and a thorough review of their maternal care services as well as other medical specialties.

“The Level IV verification affirms not only the advanced capabilities of our institution but also the unwavering dedication of our maternal care team—especially our extraordinary nurses, who bring a rare combination of clinical expertise, compassion and readiness to respond to even the most complex maternal-fetal challenges,” said David Marshall, JD, DNP, RN, Cedars-Sinai senior vice president, chief nursing executive and chair of the Department of Nursing.

The Maternal Levels of Care Verification program will also help strengthen awareness of a regionalized approach to care for mothers where needed.

“This prestigious recognition reflects the outstanding professionalism of our multidisciplinary clinical teams who care for these vulnerable patients. The comprehensive management of the highest level of obstetric care is a hallmark of Cedars-Sinai’s service to our community,” said Shlomo Melmed, MB, ChB, executive vice president of Medicine and Health Sciences, dean of the Medical Faculty and the Helene A. and Philip E. Hixon Distinguished Chair in Investigative Medicine.

When pregnant patients receive the right level of care for their unique needs, it leads to safer births and healthier moms and babies.

“Importantly, most women in the U.S. appropriately give birth at Level I and Level II facilities with excellent outcomes. But one of the keys to reducing maternal morbidity and mortality is matching the level of care a patient requires with the right hospital,” Kilpatrick said.

“This ‘triage’ approach means that most women can stay in their communities, closer to home, family and support. But if things do not go as planned, the highest level of care can be readily available to them.”

Read more on our Cedars-Sinai Blog: Keeping Time With the Baby Blues

The one-hour virtual program, Embracing Our Community: LIVE! Advancing Black Maternal Health, focused on why Black women are three times more likely to die from pregnancy-related causes than white women--a disparity that transcends education, socioeconomic status, and even pre-existing health conditions.

“The inequities around black maternal health in America are critical for us to keep at the forefront of our work,” said Christina Harris, MD, vice president and chief health equity officer at Cedars-Sinai, who moderated the discussion. “This issue embodies every challenge we face in healthcare today, from inequitable access to timely and high-quality care to disparate treatments and outcomes.”

Joining Harris was Kimberly Gregory, MD, MPH, vice chair of Women's Healthcare Quality and Performance Improvement in the Department of Obstetrics and Gynecology, and director of Maternal-Fetal Medicine at Cedars-Sinai; Sarah Kilpatrick, MD, PhD, chair of the Department of Obstetrics and Gynecology at Cedars-Sinai; Sonya Young Aadam, CEO, California Black Women's Health Project; and Natalie Hernandez, PhD, executive director, Center for Maternal Health Equity at Morehouse School of Medicine.

Panelists identified living conditions and experiences that contributed to Black women’s high maternal mortality rate, such as access to healthcare and prenatal care, trauma, childhood abuse, racism, unconscious bias, and sexism.

The panelists also discussed the persistence of disparities in Black maternal health across different socioeconomic levels, emphasizing that economic circumstances alone cannot explain inequities. They also stressed the need to eliminate racism in healthcare as well as in the daily lives of Black families, because of racism’s negative impact on health outcomes.

Conditions such as diabetes, hypertension, and obesity have increased among Black women, leading to complications, including preeclampsia, higher cesarean rates, and an increased risk of bleeding disorders.

"What's happening is that many symptoms experienced by women during pregnancy are often considered typical, when in reality, some of them can be indicative of significant morbidity and mortality,” said Gregory. “As physicians, we must learn to listen and differentiate these symptoms over time.”

Panelists gave advice for pregnant women and their families, emphasizing the importance of open communication with healthcare providers, seeking immediate care for urgent warning signs, documenting pregnancy history, and maintaining healthcare and social support systems throughout the pregnancy journey.

“For years we've had guidelines make in-hospital care better, but most deaths are actually postpartum,” said Kilpatrick. “We need to do a better job of making, what’s now being called the fourth trimester, postpartum care for women after giving birth easier. Make it covered by insurance, provide accessible follow-up, whether virtual or in-person, to ensure mothers can receive care in their own environment.”

Panelists also identified changes in policy and the healthcare delivery system that are essential for improving Black maternal health in the United States. These changes include: 

• Reviewing the causes behind every maternal death
• Ensuring access to prenatal and maternal care
• Addressing social factors like housing, transportation, and food insecurity
• Increasing diversity among healthcare professionals.

“My hope is sort of echoing Martin Luther King's dream and that one day it won't matter what color your doctor is, that you're going to get the right care at the right time for your right condition,” Gregory said.

Read more on the Cedars-Sinai Blog: How Cedars-Sinai is Working to Improve Black Maternal Health